In network

[gderilus]

I have a provider that wants to bill BCBS but she's not in network with them. Can she still see patients and bill Blue Cross/Blue Shield. Would she get pay for her services.

[Pay_My_Claims]

she will be paid at the out of network rate, if they have out of network benefits. The rate of pay is considerably less for out of network providers, and also bcbs (of NC) send payments to the clients instead of the provider when you are non-par.

[gderilus]

if the patient has copay, do you still collect copay even if you billing out of network or do you get full payment from the insurance company.

[NuBiker]

If you have time, go online, and find out how to get the doc to become an in-network provider.
There will be a form for the doc to fill out, as well as a list of all the info she has to submit to them.
It will make your job easier if your doc can become a participating provider.
Another thing, get a list of all the insurances the doc belongs to, and get a login at each of their websites.

Nu

[Pay_My_Claims]

if the patient has copay, do you still collect copay even if you billing out of network or do you get full payment from the insurance company.

if you are OON, you can collect 100% of your charge up front, since as an OON provider, you can balance bill the patient. You can then file non-assigned and the client will get whatever the ins company reimburses the claim at. Being OON it is really better to collect up front.

[dfranklin]

I agree with Charlene if you are OON then it only makes sense to collect 100% up front becuase most of the time the carrier will send payment to the patient in these cases.  You get paid and the patient will get reimbursed from their carrier.

[PMRNC]

You will not necessarily get 100% of your charge arbitrarily from the carrier. With all BCBS they do not honor assignment of benefits so checks will be sent to the insured/patient. However you can bill the patient for 100%. There might be deductibles, coinsurance and U&C cuts which would all be patient responsibility. I agree with the others that when dealing with non par BCBS patients to collect up front. I always alert my provider when I verify benefits and they in turn will tell the patient before the visit that they must pay at the time of service. Some of my providers that have left BCBS have also sent out letters to patients to let them know in advance.